MAST CELL ACTIVATED SYNDROME

17-20 % of the population may have this newly recognized syndrome. There is more diagnosis in Europe than USA but it is worth knowing about especially if you present with MCAS listed symptoms. A mast cell is a single cell that can behave, for example, as an immune cell, an endocrine cell or even as a sensorial neuron. Due to this, mast cells can significantly influence inflammation, tissue remodelling, host defence and homeostasis.

It is a form of white blood cell related to basophils. Yet they are individual cells and not the same or copies. Mast cells are found in most tissue of the body – they are in higher concentration where they are in close contact of the external environment – such as skin, uterus, airways and intestines.

MCAS is where there is an inappropriate release of mast cell mediators

It does not mean there are more mast cells.

Mast cell mediators can be histamine, heparin, serotonin, IL-6, IL-1, TNF alpha, interferon-Y, TGF- B, chymase, tryptase

Clinical Manifestations

Abdominal- pain, cramping, bloating, diarrhoea and/or constipation, non-cardiac chest pain, H. Pylori gastritis, malabsorption, abdominal bleeding

Oropharyngeal - burning pain, aphthous ulcers

Respiratory – cough, asthma like, dyspnea, rhinitis, sinusitis

Hepatic – Splenomegaly, high bilirubin, elevated liver transaminases. high cholesterol

Lymphatic – Lymphadenopathy

Cardiovascular – Tachycardia, BP issues, syncope, hot flushes, postural orthostatic tachycardia syndrome(POTS)

Neuropsychiatric- Headaches, neuropathic pain, polyneuropathy, decreased attention span, concentration down, forgetfulness, sleeplessness, vertigo, light headness, tinnitus

Skin- urticarial, hives, pruritus, telangiectasia, flushing, angioedema

Muscular skeletal- muscle pain, osteoporosis and osteopenia, bone pain, migratory arthritis

Bladder – cystitis

General– Fatigue, fevers, environmental sensitivities

Triggers

Environmental

• Pollen
• Food
• Animal
• Dust

Pathogens

• Viruses – eg. CMV
• Bacteria
• Fungus/mold
• Parasites

Toxins

• Microbial
• Heavy metal
• Pesticides/ glycophosphates
• BPA
• Alcohol

Stress

Hormones- estradiol. The uterus is full of them and so period time can be worse.

Microbiota - gut lining

Diet – High histamine foods can aggravate, however I believe are not the cause, of MCAS.

Testing for MCAS

It is very hard to test in Australia.

Histamine plasma > 8mmol/L

Chromogronin- A – 2 assays normal is 0-15ng/ml 0r 1-95ng/ml

Test for triggers mentioned above

Staining on tissue- CD117+

Treatments

ORTHODOX

• H1 blockers – loratadine, fexofenadeine, cetirizine, diphenhydramine, hydroxyzine
• H2 blockers – ranitdine, famotidine, cimetidine
• Leukotriene inhibitor- montelukast, zafirulast
• Mast Cell Stabilizers- cromolyn sodium, ketotifen
• Corticosteroids
• Benzodiazepines
• Low dose Nalterexone
• Omalizumab
• Imatinib

NATURAL REMEDIES and APPROACHES

• Low histamine eating - see below
• Quercitin- better than cromolyn sodium. Found in foods like moringa (comparable to ketotifen), capers, Note -Bad for gene SNP -COMT AA
• Watercress
• GABA and pregaba
• Progesterone and plant based progesterone
• Testosterone and plant based testosterone
• Melatonin
• Ginger is a H2 blocker and a mast cell stabilizer
• Pea Sprouts- plant amine oxidase high in DAO
• Olive Extract
• Berberine – binds heparin, Potent CYP2D6, CYP2C9, inhibitor and weak CYP3A4 inhibitor.
• Andrographis – interferes with T cell activation decreasing autoimmune response and has antimicrobial properties. Decreases T cell response/ decreased Th2. Decreased IL- 10, TNFa so decreases inflammation
• Inhibits NF- KB
• Curcumin- mast cell stabilizer
• Resveratrol- mast cell stabilizer
• Broccoli sprouts
• Methylation – MTHF, B12, B2, B6
• Antihistamine Herbs and Spices-Amaranth seeds, anise, basil, berberine, caraway, chamomile, chili powder, cinnamon, clove, curry powder, echinacea, wild oregano, fennel, fig, ginger, ginkgo, grapefruit, nutmeg, passionflower, tarragon, turmeric, skullcap, thyme, yarrow, papaya, reishi mushroom, stinging nettle

If histamine production is increased due to mast cell production it is worth considering a person’s current orthodox medications. This is a list of orthodox medications that can influence histamine levels. If a person with this condition is on these then it could be making the condition more complicated. If concerned discuss with your medical doctor.

• Non-steroidal anti-inflammatory drugs (ibuprofen)

• Antidepressants (Cymbalta, Effexor, Prozac, Zoloft)

• Immune modulators (Humira, Enbrel, Plaquenil)

• Antiarrhythmics (propanolol, metaprolol, Cardizem, Norvasc)

• Aspirin – Histamine liberator

• Amitriptylene – DAO blocker

• Valium – DAO Blocker

• Lasiks – DAO Blocker

• Codeine – Histamine Liberator

• Augmentin – DAO Blocker

• Chloroquinine – DAO Blocker and Histamine liberator

• Quinine – Histamine liberator

• All X-ray contrast – Histamine liberator

• Metoprin – HNMT blocker

• Opiates (Heroin/Morphine…) – Histamine liberator

• Thiamine/Vit B1 – Histamine liberator

Dietary Recommendations and Histamine

While eliminating high-histamine foods from your diet is a great idea, diet alone is NOT a long term correction. It is a multifactorial approach that helps the most. Treating the triggers is a good start.

• Avoid or reduce eating canned foods and processed or ready-made meals.

• Avoid or reduce eating ripened and fermented foods (older cheeses, alcoholic drinks, products containing yeast)

• Histamine levels in foods vary, depending on how ripe, matured or hygienic the foods.

• As much as it is possible, only buy and eat fresh products.

• Don’t allow foods to linger outside the refrigerator – especially meat products
 

AVOID or LIMIT FOODS HIGH IN HISTAMINES

• Alcohol – esp. wine, champagne and beer.

• Pickled or canned foods – sauerkraut, pickles, mayonnaise, olives 

• Matured cheeses, including goat cheese

• Cured/Smoked meat products – salami, ham, sausages, bacon, salami, pepperoni, lunch meats and hot dogs

• Shellfish

• Various species of fish: mackerel, mahi-mahi, tuna, anchovies, sardines

• Beans and pulses – chickpeas, soy beans, peanuts

• Nuts – walnuts, cashew nuts, cashews, and peanuts

• Chocolates and other cocoa based products

• Avocados, eggplant, spinach, and tomatoes

• Most citric fruits, apricots, prunes, dates, figs, raisins

• Wheat based products

• Vinegar

• Processed and Ready-made meals

• Salty snacks, sweets with preservatives and artificial colourings  

• Soured foods: sour cream, sour milk, buttermilk, sour dough bread

Foods that are Histamine Liberators

• Most citric fruits – kiwi, lemon, lime, pineapple, plums…

• Cocoa and chocolate

• Nuts

• Papaya

• Beans and pulses

• Tomatoes

• Wheat germ

• Additives – benzoate, sulphites, nitrites, glutamate, food dyes
 

AVOID Drinks that are Diamine Oxidase (DAO) Blockers

• Alcohol

• Black tea

• Energy drinks

• Green tea

If you feel this might fit your symptoms and need to speak to a practitioner about this please let us know and we will find you an appointment. For Bookings click here